Equity, access and utilisation in the state-funded universal insurance scheme (RSBY/MSBY) in Chhattisgarh State, India: What are the implications for Universal Health Coverage?

Abstract

Universal Health Coverage (UHC) has provided the impetus for the introduction of publicly-funded health insurance (PFHI) schemes, involving the private sector, especially in low-and middle-income countries with mixed health systems. Although equity is considered as being core to UHC, the implication of UHC interventions for equity in access (availability, affordability and acceptability) beyond financial protection is inadequately researched. India introduced a national PFHI scheme (Rashtriya Swasthya Bima Yojana) in 2007 which has since then been expanded considerably through the Pradhan Mantri Jan Aarogya Yojana (PMJAY) scheme. However, contestation remains as to whether PFHI schemes are the most appropriate interventions for UHC in India. Evidence so far provides cause for concern regarding their impact on financial protection and health equity. With PFHI schemes burgeoning globally, there is an urgent need for a holistic understanding of the pathways of impact of these schemes, including their roles in promoting equity of access and achievement of UHC objectives. The state-funded universal health insurance scheme (RSBY/MSBY) in Chhattisgarh State provided the opportunity to explore these pathways of impact, especially on vulnerable communities, as the State has a universal health insurance scheme. This PhD aims to study equity, access and utilisation in the state-funded universal insurance scheme in Chhattisgarh State of India, in the context of Universal Health Coverage. It is presented as a thesis by publications.